J Korean Orthop Assoc.  2014 Apr;49(2):107-117. 10.4055/jkoa.2014.49.2.107.

Navigation Guided Open Wedge High Tibial Osteotomy

• Seon JK
• Kim HS
• Kim DY
• Song EK

• KMID: 2185215
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.107

Abstract

Navigation systems are currently being widely used in orthopedic surgery. The mechanical axis alignment can be judged accurately via a navigation system. High tibial osteotomy (HTO) is a procedure that aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. And, by using a navigation system, accurate multiplane measurements of the lower limb alignment can be performed intraoperatively in real time, and alignment adjustments can be made as the surgeon desires. Compared with the conventional cable-method, computer navigation significantly improves the accuracy of postoperative leg axis, reduces correction variability with fewer outliers, and reduces radiation time. This paper reviews the advantages, clinical results, complications, pitfalls, and posterior tibial slope control in navigation guided open wedge HTO.

Keyword

navigation; computer-assisted surgery; knee; osteotomy

MeSH Terms

Axis, Cervical Vertebra
Body Weight
Cartilage, Articular
Knee
Leg
Lower Extremity
Orthopedics
Osteotomy*
Surgery, Computer-Assisted

Figure

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  Figure 1 Optical navigation system. Appearance (A), monitor (B, C).

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  Figure 2 Electromagnetic navigation system. (A) A structure: monitor, detector. (B) Intraoperative instrument.

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  Figure 3 The cable method for assessment of intraoperative leg alignment is not accurate because it depends on limb rotation and alignment guide position.

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  Figure 4 Intraoperative leg alignment measured using a navigation system before (A) and after valgus opening (B). The mechanical axis was adequately corrected without increasing posterior slope.

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  Figure 5 Aescular open wedge plate system.

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  Figure 6 The surgical procedures. (A) The Pes anserius was retracted and the superficial medial collateral ligament was clearly visualized. (B) Oblique tibial tuberosity osteotomy. (C) Valgization by the stepwise insertion of three coupled chisels, and measurement of the opening gap. (D) Wedge shaped opening and open wedge plates.

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  Figure 7 Preoperative (A) and postoperative (B) radiographs showing satisfactory alignment without change in posterior slope; 6 mm anterior and 9 mm posterior plates were used.

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